The Way Forward: High-Dose, Short-Course Levofloxacin Leads the Field

29 March, 2018

Question 6

Could you comment on the fluoroquinolone coverage of Pseudomonas aeruginosa?

For many years ciprofloxacin was considered to be the antipseudomonal fluoroquinolone but it is now well established that levofloxacin and ciprofloxacin have similar sensitivities (46) and, in fact, the 750 mg levofloxacin regimen may be more active. However, it is important to remember that, when treating patients in whom P. aeruginosa may be implicated, single fluoroquinolone therapy is not advocated and should be used in combination with an additional antipseudomonal agent such as imipenem-cilastatin. Levofloxacin has been approved in the United States as one of the agents for treating nosocomial pneumonia due to P. aeruginosa.Regimens for treatment of P. aeruginosa in the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) Consensus Guidelines on the Management of CAP in Adults (47) include:

An antipneumococcal, antipseudomonal β-lactam (piperacillin-tazobactam, cefepime, imipenem, or meropenem) plus either ciprofloxacin or levofloxacin (750 mg).
Or, the above β-lactam plus an aminoglycoside and azithromycin.
Or, the above β-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone penicillin-allergic patients, substitute aztreonam for the above β-lactam) (moderate recommendation; level III evidence).